CMS Sensory Assignment

Answer each ques6on along with the ra6onales for each answer

Name:

Age-Related Macular Degenera6on

Pa6ent Profile P.J. is a 74-year-old woman who has been seen mul7ple 7mes in the past with a complex medical history. Most recently, she was discharged 1 month ago a@er a 14-day stay for gangrenous open cholecystectomy. The gangrene extended into the common bile duct, and she had a bile leak postopera7vely. On this visit to the emergency department, she is repor7ng diminished vision in her le@ eye for the past seven days. She is currently taking the following medica7ons:

• Valsartan 160 mg/25 mg PO daily

• Amitriptyline 25 mg PO daily

• Aspirin 81 mg PO daily

• Alprazolam 0.25 mg every 6 hours as needed for anxiety

Subjec6ve Data • States her vision has become “fuzzy and distorted” in the le@ eye • States, “I survived that horrid ordeal with my gallbladder, and now I have trouble with my

vision.” • Never married; has a good support system with friends and caretakers

Objec6ve Data Physical Examina.on • Blood pressure 119/79, pulse 82, temperature 97.7°F, respira7ons 16 • Alert and oriented to person, place, and 7me • Diminished breath sounds bilateral lower lobes posteriorly • Oxygen satura7on 96% on room air

Discussion Ques6ons 1. Name six poten7al causes of P.J.’s blurry vision.

2. What addi7onal health history informa7on would you obtain from P.J.?

3. What will you include in P.J.’s focused assessment?

Case Study Progress

A consult is sent to the on-call ophthalmologist. The ini7al examina7on results show a scar in the central area (macula), sugges7ng age-related macular degenera7on (AMD). The ophthalmologist feels at this point that the treatment should be aimed at preven7ng further vision loss and schedules P.J. for photodynamic therapy.

4. What are the early signs of AMD?

5. What tests can be done to determine if P.J. has AMD?

6. What risk factors are associated with AMD?

7. What diet related teaching will you provide P.J.?

Meniere’s Disease

Pa6ent Profile S.H. is a 25-year-old man who comes to the emergency department with a history of one day of severe ver7go and vomi7ng.

Subjec6ve Data • Has had ver7go spells with right-sided 7nnitus a few 7mes this past month • States he becomes nauseous when he acempts to sit up • Ver7go is worse with head movement • Has been crawling out of bed for fear of falling • Currently repor7ng nausea

Objec6ve Data Physical Examina.on • Blood pressure 139/72, pulse 90, temperature 97.7°F, respira7ons 22 • Spontaneous nystagmus in the right eye • Vomited two 7mes in past 30 minutes • Intermicent diaphoresis Diagnos.c Studies • Audiogram: severe sensorineural hearing loss at 35.0 dB, with a predominance of low frequency

impairment in the right ear • Tuning fork–Weber test: right sensorineural hearing loss

Discussion Ques6ons 1. What is ver7go? How is it different from dizziness?

2. Based on the assessment, what do you think S.H. has and why?

3. What other diagnos7c tests may be ordered for S.H.?

4. The health care provider diagnoses S.H. with Meniere’s disease. What are the common causes of Meniere’s disease?

5. What are the priority nursing diagnoses for S.H?

6. S.H. is being discharged with prescrip7ons for prochlorperazine and diazepam and recommenda7ons to follow up with his primary care provider in 3-4 days. What should your discharge teaching for S.H. include?